Eli Lilly’s “Ozempic-in-a-pill” candidate just cleared its most significant clinical hurdle to date. The pharmaceutical giant announced that its experimental once-daily pill, orforglipron, met all primary and secondary endpoints in two pivotal Phase 3 trials: ACHIEVE-2 and ACHIEVE-5. Data indicate that this oral treatment provides superior glycemic control compared to both a standard SGLT-2 inhibitor and a placebo. If approved, this small-molecule agonist could fundamentally disrupt the diabetes landscape by offering the high-potency results of injectables in a convenient daily tablet.
The findings, released in October 2025, show that orforglipron achieved significant reductions in A1C levels — the standard measure of average blood sugar — and body weight over a 40-week period. Unlike current oral GLP-1 options, orforglipron is a non-peptide, small-molecule drug. This chemical structure is clinically significant; while “peptide” drugs are proteins usually digested by stomach enzymes, this non-peptide version is sturdy enough to be absorbed as a pill without restrictive food or water requirements.
Orforglipron belongs to the GLP-1 (glucagon-like peptide-1) receptor agonist class, mimicking a gut hormone that triggers insulin release and slows digestion. In contrast, SGLT-2 inhibitors work through the kidneys by flushing excess sugar out through urine. Lilly’s latest data suggests that orforglipron’s hormonal pathway offers more robust glycemic lowering than this renal-focused approach.
The ACHIEVE program evaluates orforglipron across five global registration trials. While earlier studies outperformed oral semaglutide, the results from ACHIEVE-2 and ACHIEVE-5 provide the definitive evidence of superiority over existing standards of care.
Beyond glycemic control, orforglipron delivered improvements in cardiovascular risk factors. The safety profile remained consistent with the broader GLP-1 class; mild-to-moderate gastrointestinal events were the most common side effects, with no liver safety concerns observed.
In the ACHIEVE-2 trial, which compared orforglipron directly to the SGLT-2 inhibitor dapagliflozin, patients inadequately controlled on metformin who received a 36 mg dose of orforglipron saw an A1C reduction of 1.7%. This more than doubled the 0.8% reduction observed in the SGLT-2 group. “Orforglipron has now demonstrated superiority over two active comparators,” stated Jeff Emmick, senior vice president of product development at Lilly Cardiometabolic Health, reinforcing its potential as a new standard of care.
The ACHIEVE-5 trial evaluated a more complex population: adults using titrated insulin glargine. In this trial, the glargine dose was constantly adjusted to find the exact amount needed to keep fasting blood sugar stable. The study was significant because it showed that adding orforglipron to insulin glargine helped patients lower their A1C by an additional 2.1%, compared to 0.8% in the placebo group. This is important because many patients find that insulin alone is not enough to reach their health goals, or it causes unwanted weight gain. Adding orforglipron helped manage blood sugar more aggressively while also promoting weight loss. Beyond glycemic control, orforglipron delivered improvements in cardiovascular risk factors. The safety profile remained consistent with the broader GLP-1 class; mild-to-moderate gastrointestinal events were the most common side effects, with no liver safety concerns observed. Lilly plans to submit orforglipron for regulatory approval in 2026. If authorized, it would remove the logistical barriers of injections and strict fasting, offering a flexible, “no-restriction” oral option for the global diabetes community.
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